News Releases

Harrisburg, Pa. – Capital BlueCross today announced that quantity limits enacted in July 2017 are showing promising results in combatting the opioid epidemic. Between the second and third quarter of 2017, the amount of opioid tablets dispensed to Capital BlueCross members decreased by 42-percent. The total amount of members using opioids was also reduced by 12-percent. We were able to accomplish this due to our close working relationships with our provider partners.

Since putting quantity restrictions in place, Capital BlueCross only allows coverage for a one-week supply (7-days) on all short-acting opioids such as hydrocodone/ acetaminophen and oxycodone IR. Prior authorization and quantity limits are also in place for long-acting opioids.

The quantity limitations are based on the particular drug being prescribed and the dosage strength. The limitations are aligned with Centers for Disease Control (CDC) recommendations for acute and chronic pain.

Capital BlueCross works with physicians, government agencies, and our communities to ensure opioids are prescribed in accordance with medical research, direction from the CDC, and in the best interest of our members’ health.

“Since the limitations were put into place, we have also seen a decrease in the dosage strength prescribed to our members. This is promising, because the higher the dosage of an opioid, the more likely someone is to have an adverse outcome, including the potential development of substance use disorder and addiction,” said Dr. Jennifer Chambers, Capital BlueCross, Chief Medical Officer. “We take our role in fighting this epidemic very seriously. Eighty percent of first time heroin users previously used/misused prescription opioids. That is why it is critical that we do our part to stem the flow of prescription opioids in our communities.”

Other steps taken by Capital BlueCross to battle the opioid epidemic include:

• Advocating for non-opioid pharmacological therapies first and enhanced coverages for non-pharmacological treatments for pain such as acupuncture, bio-feedback, and chiropractic care.
• Continuously working to improve clinical management of opioid use and how we help our members manage pain.
• Actively supporting drug take-back initiatives, including the ability to safely discard unused medications at our Capital Blue health and wellness centers.
• Expanding the use of the safety and monitoring program from CVS Health, which enables pharmacists to identify and report suspected opioid misuse to a member’s doctor and other prescribers, including alerts to prescribers and dispensers of opioids when members receive an opioid prescription from more than one prescriber, or for more than one drug class, such as the addition of benzodiazepines like Xanax.
• Providing medication assisted treatment, which covers medication prescribed to help individuals overcome addiction, as a covered benefit for our members.
• Partnering with experts to provide programs offering personalized support to our members dealing with chronic pain; these programs are targeted to help alleviate symptoms and improve quality of life.

Capital BlueCross has also contributed $200,000 to law enforcement officers in our service area since 2014 to purchase naloxone. This life-saving medication can revive a person who is suffering a potentially fatal overdose.